Pathways to the diagnosis of lung cancer in the UK: a cohort study

Jacqueline Barrett¹ and William Hamilton¹^,2

¹CAPER research unit, Exeter EX4 5BW, UK

²Academic Unit of Primary health Care, University of Bristol, 25-27 Belgrave Road, Bristol, BS8 2AA, UK

author email corresponding author email

BMC Family Practice 2008, 9:31doi:10.1186/1471-2296-9-31


Published:	18 May 2008

Abstract

Background

Lung cancer is the commonest cause of cancer death in the UK. Patients generally present to their general practitioner, but the pathway of diagnosis from first symptom to diagnosis has not been mapped. We performed a cohort study of 246 patients with lung cancer in Exeter, Devon UK. All patients had their cancer symptoms, referrals and diagnoses identified and dated using their doctors' records.

Results

Three main routes to diagnosis emerged. The first was the expected route of outpatient referral; 150 (61% of the cohort) of patients took this route, although only 110 (45% of the whole cohort, 73% of those referred to outpatients) were referred to a respiratory department. 56 (23%) were admitted as an emergency, having previously described a lung cancer symptom to their doctor. 26 patients (11%) had no symptom of lung cancer reported before their diagnosis. The interval from first symptom to referral was similar across the different pathways. However, the referral to diagnosis interval was longer in patients misdirected to other outpatient departments (66 days, interquartile range 37,110) than those sent to respiratory clinics (29 days, 17,61) or admitted as an emergency (16 days 8,40); p < 0.001.

Conclusion

Only a minority of lung cancer patients follow the traditional route to diagnosis. Clinical and research efforts need to consider the alternative routes if they are to maximise their impact on speed of diagnosis.